Respiratory syncytial virus is the most common cause of bronchiolitis, an infection of the small airways in children under 2. Treatment is supportive, so the main job is to keep the infant breathing, fed and hydrated while watching for apnea in very young babies.
Key symptoms
- Runny nose and cough that worsen over 3 to 5 days
- Fast or labored breathing
- Wheezing
- Poor feeding and fewer wet diapers
- Pauses in breathing in young or preterm infants
What you find on exam
- Respiratory rate, retractions, nasal flaring and grunting
- Crackles and wheeze on both sides
- Oxygen saturation
- Hydration: mouth, fontanelle and diaper count
Tests
- Diagnosis is clinical; routine tests are not needed
- Viral swab (RSV PCR) only if it changes care
- Chest X-ray only if severe or atypical
Treatment basics
- Nasal suctioning, especially before feeds
- Oxygen if saturation stays below 90%
- Fluids by nasogastric tube or IV if feeding is poor
- Albuterol, steroids and antibiotics are not recommended
- Prevention: nirsevimab for infants, or RSV vaccine during pregnancy
Red flags
- Pauses in breathing or cyanosis
- Severe retractions, grunting or exhaustion
- Poor feeding with signs of dehydration
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Sources: NCSBN 2026 NCLEX-RN Test Plan; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.